Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM:
Tadalafil is an oral drug that is used for treating impotence
(the inability to attain or maintain a penile erection). It is in a
class of drugs called phosphodiesterase inhibitors that also includes sildenafil
(Viagra) and vardenafil (Levitra).
Erection of the penis is caused by the filling of the penis with blood.
Filling occurs because the blood vessels that bring blood to the penis increase
in size and deliver more blood to the penis, and, at the same time, the blood
vessels that take blood away from the penis decrease in size and remove less
blood from the penis.
Sexual stimulation that leads to an erection causes the production and
release of nitric oxide in the penis. The nitric oxide causes an enzyme,
guanylate cyclase, to produce cyclic guanosine monophosphate (cGMP). It is the
cGMP that is primarily responsible for increasing and decreasing the size of the
blood vessels carrying blood to and from the penis, respectively, and causing
the erection. When the cGMP is destroyed by another enzyme, phosphodiesterase-5,
the blood vessels return to their normal size, blood leaves the penis, and the
erection ends. Tadalafil prevents phosphodiesterase-5 from destroying cGMP so
that cGMP stays around longer. The persistence of cGMP leads to a more prolonged
engorgement of the penis with blood.
Tadalafil was approved by the FDA in November 2003.
PRESCRIPTION: Yes.
GENERIC AVAILABLE: No.
PREPARATIONS: Tablets: 5, 10, and 20 mg.
STORAGE: Store at room temperature between 15-30 C (59-86 F).
PRESCRIBED FOR: Tadalafil is used for the treatment of impotence
(erectile dysfunction, ED).
DOSING: For most individuals, the recommended starting dose of tadalafil is
10 mg per day taken before sexual activity. Depending on the adequacy of the
response or side effects, the dose may be increased to 20 mg or decreased to 5
mg a day. The effect of tadalafil may last up to 36 hours. Individuals who are
taking medications that increase the blood levels of tadalafil should not exceed
a total dose of 10 mg in 72 hours (See drug interactions). Tadalafil may be
taken with or without food since food does not affect its absorption from the
intestine.
DRUG INTERACTIONS: The breakdown and elimination of tadalafil from the body
may be decreased by erythromycin, ketoconazole (Nizoral), itraconazole
(Sporanox), indinavir (Crixivan) and ritonavir (Norvir). Therefore, these drugs
may increase the levels of tadalafil in the blood. If these drugs are being used
at the same time as tadalafil, the dose of tadalafil should be reduced in order
to avoid side effects from high levels of tadalafil.
Tadalafil exaggerates the increases in heart rate and lowering of blood
pressure caused by nitrates, for example, nitroglycerin, isosorbide dinitrate (Isordil),
isosorbide mononitrate (Imdur, Ismo, Monoket), nitroglycerin (Nitro-Dur,
Transderm-Nitro) that are used primarily for treating heart pain (angina). In
patients who take nitrates for angina, tadalafil could cause heart pain or
possibly even a heart attack by exaggerating the increase in heart rate and the
lowering of blood pressure. Therefore, tadalafil should not be used with
nitrates.
Tadalafil also exaggerates the blood pressure lowering effects of some
alpha-blocking drugs for example, terazosin (Hytrin) that primarily are used for
treating high blood pressure or
enlargement of the prostate. Individuals who
take these alpha-blockers should be on a stable dose of the alpha-blocker before
tadalafil is started. In such situations, tadalafil should be started at the
lowest dose. If the patient is already taking tadalafil, the alpha-blocker
should be started at the lowest dose. Tadalafil and alcohol both lower blood
pressure. Therefore, combining tadalafil with alcohol may cause excessive drops
in blood pressure and cause dizziness,
headaches, and increased heart rate.
Impotence, also known as erectile dysfunction, is a common
problem among men characterized by the consistent inability to sustain an
erection sufficient for sexual intercourse or the inability to achieve
ejaculation, or both. Impotence can have emotional causes but most often it is
due to a physical problem.
Enjoying a satisfying sex life as we age is important to both physical and mental health. As we age, diseases and conditions may pose challenges in our sexual health, and sexual experiences. Learn how to manage your conditions and still have a gratifying sex life as you age.
Sexual health information including birth control, impotence, herpes, sexually transmitted diseases, staying healthy, women's sexual health concerns, and men's sexual health concerns. Learn about the most common sexual conditions affecting men and women.
Having diabetes can mean early onset and increased severity of bladder symptoms (urinary incontinence and urinary tract infections) and changes in sexual function. Men may have erectile dysfunction; and women may have problems with sexual response and vaginal lubrication. Keep your diabetes under control, and you can lower your risk of sexual and urologic problems.
Introduction to sexual and urological problems of diabetes
Troublesome bladder symptoms and changes in sexual function are common health problems as people age. Having diabetes can mean early onset and increased severity of these problems. Sexual and urologic complications of diabetes occur because of the damage diabetes can cause to blood vessels and nerves. Men may have difficulty with erections or ejaculation. Women may have problems with sexual response and vaginal lubrication. Urinary tract infections and bladder problems occur more often in people with diabetes. People who keep their diabetes under control can lower their risk of the early onset of these sexual and urologic problems.
Diabetes and sexual problems
Both men and women with diabetes can develop sexual problems because of damage to nerves and small blood vessels. When a person wants to lift an arm or take a step, the brain sends nerve signals to the appropriate muscles. Ne...
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